Hiatal hernia is one cause of heartburn

DEAR DR. DONOHUE: Will you write about hiatal hernia? I have had this for a long time. What are the cause and the treatment?

Paul G. Donohue, M.D.

DEAR DR. DONOHUE: Will you write about hiatal hernia? I have had this for a long time. What are the cause and the treatment?

— Anon.

I have to start with some anatomy. The esophagus is the muscular tube through which food passes. It runs from the throat to the stomach. To reach the stomach, it must pass through the diaphragm, a large, horizontal muscle that separates the chest cavity from the abdominal cavity. Fortunately, nature arranged for a hole in the diaphragm through which the esophagus can connect with the stomach. That hole is called a hiatus. A hiatal hernia is an upward bulge of the stomach through the hiatus and into the chest cavity.

Sometimes, but not always, a hiatal hernia is responsible for the regurgitation of stomach acid and digestive juices into the esophagus. When that happens, a person suffers from heartburn. The official name for heartburn is GERD, gastroesophageal reflux disease. Hiatal hernia isn't a synonym for heartburn as it is often used. It's only one cause of heartburn. And, to repeat, it doesn't always lead to heartburn.

When a hiatal hernia produces no symptoms, no treatment is needed. When it brings on heartburn, heartburn is treated with a change of diet and a change of a few lifestyle practices; sometimes medicines is the therapy taken. Don't eat any foods that trigger heartburn: chocolate, peppermint, citrus fruits, fatty foods, tomatoes and colas. Don't lie down after eating. Put 6-inch blocks under the posts at the head of the bed to keep stomach juices in the stomach while sleeping. Many medicines can suppress the production of stomach acid. Prilosec, Prevacid, Nexium and Aciphex are a few of their names.

Should medicines fail to control heartburn in a person with hiatal hernia, surgical correction of it will.

DEAR DR. DONOHUE: Will you please explain the difference between pneumonia and walking pneumonia? Which is more serious?

— M.V.

Pneumonia is lung inflammation. Usually, it results from an infection of bacteria or viruses. Not always. Poison gas and toxic fumes also cause pneumonia.

Walking pneumonia applies to pneumonia caused by mycoplasma (MIKE-oh-PLAS-muh), a very small bacterium. Quite often, mycoplasma pneumonia is a self-limited infection that is not life-threatening. People with this kind of lung infection frequently are able to be up and about — walking around. That's where the name comes from.

Walking pneumonia usually is less serious than bacterial or viral pneumonia.

Frankly, it's a term not regularly used these days.

Readers may write him or request an order form of available health newsletters at P.O. Box 536475, Orlando, FL 32853-6475.